Hospital Revenue Cycle Management Solutions in 2018

When it comes to hospital revenue cycle management (RCM), the solution often involves a change in paradigm and thinking by your RCM team toward value-based care and upfront collection. Health information technology (HIT) analytics are central to your solution.

As an article from RevCycle Intelligence pointed out in 2017, “Healthcare executives often point to market factors for lackluster hospital revenue cycle performance. But lagging accounts receivable days and shrinking hospital margins usually indicate that it is time for an internal hospital revenue cycle turnaround project, stated Derek Pierce of the consulting firm Healthcare Management Partners (HMP).”

In another article from RevCycle Intelligence about value-based care and analytics, the editors first observe that “there has been a much greater push toward value-based care reimbursement and away from fee-for-service payment programs. This has led to the development of bundled payment contracts, accountable care organizations, and CMS projects such as the Comprehensive Care for Joint Replacement Model.” It is the value-based care focus that leads organizations to turn to value smart analytics. It’s how the transition is facilitated: “value-based care reimbursement will change the revenue cycle by transitioning an organization from a transactional type of payment system to taking on more revenue cycle analytics.”

Becker’s Hospital Review, in a recent article on hospital revenue cycle management first notes that “for hospitals and health systems in the midst of transitioning from fee-for-service to value-based care, new financial and alignment strategies are crucial to success.” They then detail a recent panel discussion where the focus was on “investment in outpatient care”, and “driving down costs through physician alignment”. In a related article on “financial challenges facing hospitals, health systems”, Becker’s editors provide some key takeaways for how to “reduce costs while also improving quality and maintaining a strong workforce,” including:

Recruiting and retaining physicians

Investing in service lines to spur revenue growth

Organizations must focus more on how they collect dollars from patients to maximize reimbursement

Health systems with smart analytics focused cost and quality outcomes, help employees be more informed and make better decisions

“If you’re getting reimbursed less upon how many activities that you do and there is some sort of performance-driven element to that, you have to measure those performance elements, and then how you are doing against those elements, and then what insight you bring back to the rest of the organization to then drive additional payments or reduction of penalties.” — Dr. Garry Choy, MD, Radiologist at Massachusetts General Hospital, from an article in RevCycle Intelligence

A Health Catalystarticle on improving the revenue cycle makes the following observation: “To catch and address issues that prevent claims from being paid, revenue cycle teams need the ability to easily access data throughout the cycle. Because claims are processed every day, these teams need to constantly monitor trends and variances and quickly identify and address the root cause of performance issues. Prompt identification is critical.” We agree, and note that Health Catalyst suggests that hospital information technology teams implement an EDW — Enterprise Data Warehouse — as a key component of the recommended solution. This is fundamental to the mission of SSI Claims Analytics software which allows users to measure, identify, and improve upon strategic and operational performance goals while fostering a deeper understanding of your organization’s key performance indicators (KPIs). As we continue to evolve our revenue cycle software suite, we see smart reporting across the enterprise as a key factor in your organization’s success.

Data Analytics is one of the top five ways to optimize hospital revenue cycle management according to another article in RevCycle Intelligence. The five recommendations include:

Updating patients on medical billing is key, where a focus on managing bad debt avoidance is critical.

“Revenue cycle analytics and utilizing financial data is key to make the revenue cycle more visible through charts or graphs.”

Focus on patients that pay bills — “leverage credit scores and leverage our experience so that we identify upfront where the hiccups and troubles will be.”

Regularly “revisit daily processes to ensure everything is working smoothly”.

The need for attention to RCM solutions covered in this article is underscored by findings from Research and Markets that observes, “the global revenue cycle management market is expected to reach USD 90.43 billion by 2022 from USD 51.07 billion in 2017, at a CAGR of 12.1%. Growth in this market can primarily be attributed to factors such as decreasing reimbursements in the healthcare industry, regulatory mandates for the adoption of EHR/EMR, government initiatives to boost the adoption of RCM solutions, loss of revenue due to billing errors, and process improvements in healthcare organizations.”

The SSI Group will continue to report on smart RCM solutions as we work with 2,800 healthcare organizations across the U.S. for provider solutions to streamline workflow, increase revenue, improve efficiencies.